A dispute with nurses at DMC Sinai-Grace Hospital in Detroit highlights growing anxieties among front-line hospital workers as a surge in cases of the coronavirus grows in metro Detroit. (Detroit Free Press photo by Eric Seals)

Nurses in the emergency room at DMC Sinai-Grace Hospital took a stand late Sunday night against what they said are dangerous working conditions that put them and their patients at risk.

Salah Hadwan, a registered nurse in the emergency department at Sinai-Grace, which is in the northwest section of Detroit, the city hardest hit by the coronavirus outbreak in Michigan, said the surge in extremely sick patients coupled with nurses who have quit or been sickened by the virus, led to a crisis in staffing.

The hospital's emergency room managers are requiring those who report to work to manage more than 100 critically ill patients, many of whom are on ventilators and need critical care, he said, adding that ideally, there would be 21 nurses on staff for every shift.

"Tonight, it was the breaking point for us because we cannot take care of your loved ones out here with just six or seven nurses and multiple vents (ventilators), multiple people on drips," said Hadwan, adding that the patient load has been building for three weeks.

"There would have been nurses that had to watch up to 20 patients at a time, which is not safe," he said.

Stories from the front

Bridge Magazine and the Detroit Free Press are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives.

The night nurses asked managers to call for extra help to handle the patient load. But when they saw no relief, they staged a protest late Sunday, said Hadwan, 30, who has worked at Sinai-Grace for three years and said he has never seen working conditions like this.

"We decided to sit in our break room until they could pull in more resources to help us out for the night," he said.

"After four hours, they basically told us there was not going to be any support coming in for the night. And they told us, 'What is your decision?' We told them we were taking a stand, so they basically told us, 'You can leave.' So that meant the day-shift workers had to work the whole night, for 24 hours."

Hadwan, who also is vice president of the Hamtramck Public Schools Board of Education, posted a Facebook Live video about midnight Monday, showing the group of nurses leaving Sinai-Grace. The nurses said they love their hospital and city, but they could not take those working conditions anymore.

Brian Taylor, a spokesman for the Detroit Medical Center, said high-patient volume is driving an increased need for staffing, especially nurses.

"The DMC is using a variety of resources to help to supplement nursing staff including contracting with staffing agencies to secure more nurses and reaching out to colleges and universities to recruit nursing students who are close to graduation to assist in providing care to our patients, in accordance with state guidance," Taylor said.

“We know this is a very challenging time for caregivers. Our doctors and nurses continue to demonstrate their commitment and dedication to our patients.

"We are disappointed that last night a very small number of nurses at Sinai-Grace Hospital staged a work stoppage in the hospital refusing to care for patients. Despite this, our patients continued to receive the care they needed as other dedicated nurses stepped in to provide care.”

‘You have to give us the weapons’

Nurses throughout the state are reporting increased anxiety from a continued shortage of personal protective equipment, providing intimate care to highly contagious COVID-19 patients, while trying to keep loved ones safe at home, nurses have told the Detroit Free Press and Bridge in recent days.

“When there aren’t enough troops to fight this fight, what do you do? You retreat.” said Nina Bugbee, president of the Teamsters Local 332, which represents radiologists and respiratory therapists at McLaren Flint Hospital.

“These workers who appear to be walking away, aren’t really,” Bugbee said. “This is not something they want to do, but they are saying, ‘This is bigger than what we can handle. You have to give us the weapons to fight this, or we will lose this war.’”

Bugbee represents tens of thousands of health care workers in her role in the International Brotherhood of Teamsters, where she serves as director of the health care division.

She said the tension, building for weeks, is near a snapping point at hospitals throughout Michigan and the country.

“In Week 1, we were in shock. In Week 2, we didn’t have [personal protective equipment]. In Week 3, we realized the hazards and warnings, and now here in Week 4, the [staffing] ratios are not manageable and they are not safe.”

Nurses have "a tipping point" where "the best thing any RN can do for their patients, their families, and their coworkers is to speak out ... rather than remain silent," Jamie Brown, a critical care nurse at Borgess Hospital and the president of the Michigan Nurses Association, said in a prepared statement.

"Until hospitals start taking the concerns of nurses seriously, it’s only a matter of time before more actions like these [at Sinai-Grace] occur," she said. "It is absolutely essential that hospitals start working with nurses and stop silencing our voices."

Hospitals as well as nurses are in impossible situations, said Jeff Morawski, a long-time nurse and president of the OPEIU Local 40, which represents nurses at McLaren Macomb Hospital in Mount Clemens.

Hospitals and patients need nurses. And for many nurses, caring for others is threaded through their DNA.

Still, Morawski said, among the ranks of nurses are parents of young children and caregivers to elderly loved ones and spouses to people with underlying conditions that make them more susceptible to the virus.

Those loved ones, too, count on the nurses.

"There is a point in your life and you have to decide that your own life is worth something, and whether it's worth working without protection and putting the people you care for, the patients, in danger and your families in danger," Morawski said.

He said McLaren's nurses haven’t been pushed yet to the point reported by Sinai-Grace's night shift.

A breaking point

Kenisa Barkai, 38, of Woodhaven said she was fired March 27 from her nursing job at Sinai-Grace after speaking out about staffing and poor conditions at the hospital.

She said she was trying to form a union for the nurses before Michigan marked its first known coronavirus case, but the pandemic brought underlying problems that were simmering at the hospital to a full boil.

On March 16-17, Barkai said she was caring for seven patients, including two who had tested positive for COVID-19.

Then, she said, more patients were admitted, increasing her workload.

“I voiced my concern loud and clear that day, like this is ridiculous,” she said.

“I can't be in 100 places at one time. I was already overwhelmed and overworked. You know, we don't get to take breaks. We don't get to go to the bathroom. And with COVID patients, it's not just like, you're able to go in and out of the room — you have to take a lot of steps to protect yourself, right?”

Barkai said she repeatedly raised concerns about conditions and indicated plans to contact authorities. She posted a Facebook video showing her gown and mask, which was then featured by WDIV-TV (Channel 4). The local news station interviewed her about conditions at Sinai-Grace.

Soon after, she lost her job. The hospital system cited a violation of its social media policy, according to a document Barkai provided to the Free Press.

Taylor, the spokesman for Sinai-Grace, said he could not discuss the personnel matter.

Hadwan said the pressure for the night nurses got to be too much on Sunday.

Hadwan described an emergency department with patients filling the hallways, and nurses who wear the same mask over multiple 12-hour shifts. "The patients deserve to be in a room. They deserve to be monitored correctly," he said.

"We've had a lot of great nurses resign. We've had a few people call in because they are mentally exhausted. ... they want to be there, but it's unsafe."

Hadwan is scheduled to report to work again Monday night.

"They didn't take our badges," he said. "We all are scheduled to go back in tonight. We all plan to go in tonight, and see what happens from there. We don't quit."

He hopes people who hear about the situation will understand that COVID-19 is not a hoax or a scam, and that it is killing people.

"People are dying in large amounts. Please stay home, please. If everybody stayed home for two weeks, you know we could be saving each other just by doing that. We have to take it seriously," Hadwan said.

"If only they could see what we see. There's no words to describe it."

What happened in Detroit and the streets of at least 35 other cities reflects the raw state of urban America. Months of dealing with a killer virus. Surging economic despair. Then another viral video emerged of a Black man killed while being arrested by a white policeman in Minneapolis.

Detroiters are experiencing the highest unemployment rates of the century. Millenials and Gen Z, hit hardest by massive unemployment, have looped economic relief into their demands against police brutality as protests in support of George Floyd continue.

The killing of George Floyd, a black man, by a white policeman in Minneapolis is the catalyst for nationwide protests in at least 150 cities, suburbs and small towns. Police brutality is only part of what draws Detroit protesters. Gen Z and Millennial organizers are advocating for something new.

If you learned something from the story you're reading please consider supporting our work. Your donation allows us to keep our Michigan-focused reporting and analysis free and accessible to all. All donations are voluntary, but for as little as $1 you can become a member of Bridge Club and support freedom of the press in Michigan during a crucial election year.

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Comments

Meredith

Mon, 04/06/2020 - 3:59pm

It makes me very upset that the spokesperson for the DMC stated he was "disappointed" in the nurses. When are you [hospital authorities] going to take accountability for the problems you created? Hospitals are short staffed on many nights without a pandemic because of the $$. The general public should be disappointed in YOU

Thank you, all nurses, for all you do! Being a nurse is a noble profession and you are all underrated for everything you do! We won't make it through this pandemic without the help of nurses, so for the love of all nurses and humanity in general, please stay home!!

Staging a walkout during an emergency like this is very irresponsible even if the grievances are valid. How many patients suffered due to this? How would you like to have been a patient there during this stunt or better yet, how about if it was your loved one laying there with no care? There's a time and a place for everything and this was not the time to walk off the job.

A pandemic is technically NOT an emergency. The only people who CAN help, need to stay alive. Not to mention the further spreading to the Non-COVID. They have known way before we did how deadly and contagious this is but still keep working. The protest is the next level move. The next is they ALL die. Over 40 MDs and RNs already have. Just in the US.

Hospital and health system administrators are desperately trying to cover up their inadequacy and failures of leadership. The health care system in this country was already in crisis in many communities before the pandemic. The decades of mismanagement by the professional administrative class has led to this moment of chaos and confusion. Now it’s deflection and denial time. The front line people who object publicly will be fired and / or disciplined . In this we are little better than China with our own lie & spin “spokespersons”

The DMC's poor decisions are coming back to bite Detroit in the ass. The DMC is a for-profit hospital, owned by Tenet Corporation (from Dallas, TX). When then DMC CEO, Mike Duggan "saved" the DMC by selling it to a for-profit hospital system, what did we expect would occur ... profits over people. The DMC has been cutting jobs ever since, but the administrators are still raking in hundreds of thousands of dollars in salaries for failed leadership. Nothing like a national pandemic to finally expose it.

Sadly, there are no easy answers and no clear villains to blame in this crisis. Nurses and doctors are true heroes, and it is a tragedy that they aren't better equipped to fight this pandemic. It upsets us and causes some people to harshly judge some of them for leaving the fight to protest the poor equipment and staffing levels.Hospital administrators and boards certainly should strive to maintain adequate staffing levels and sufficient protective equipment, but our highly inequitable system of providing health care in this country make that almost impossible. This is especially true in areas which have patient populations with a high percentage of patients with Medicaid and Medicare or uninsured people. Purchasing excess inventory and maintaining more than the minimally required staff is simply not affordable for most health care systems. There have been hundreds of hospitals which closed due to this unsustainable model and the cost of providing care. Many of those were Michigan hospitals.Perhaps if the Federal Government, in particular President Trump and his administration, had treated the Coronavirus like an existential threat to the country rather than a political threat to their reelection, we may have been better prepared to fight the battles at the State level.

TJH: Thank you for saying something meaningful, meaning something which could take us all out of our overly expensive dependence upon a wholly dysfunctional health care morass. Maybe, the one good thing that this pandemic can provide is an acute and widely held understanding that there are much better ways to go. And that a dozen other international countries have already proven what these ways might be. For starters, just refer to T.R. Reid's analysis: The Healing of America (2009). You can get a used copy on ABEbooks.com for less than 10 bucks. That will probably be the best $10 bucks you have ever spent.

It is not their job to suck it up. It IS their job to advocate for their patients wearing reused contaminated masks and taking on a vent load that put's all patients at risk INCREASES mortality rates, they did the right thing by standing up for their patients. This is something ALL nurses should be doing.

I understand completely. I do not like the fact that the day shift had to cover all night, but I can tell you that the hospital was was not prepared, as most are not. Its called Metrics, and its not safe.This has been an ongoing battle between Nursing and Administration for some time. Cost containment so the hospitals and share holders can meet the projected profit margins.I have seen administration cut staff so they could get their bonuses for working "so efficiently" Lets call it what it is "so unsafe"Its easy to cover up a sentinel event, with hundreds of sheets of needless documentation. Its too costly to sue the hospitals.Nurses are leaving, its not because of this pandemic, we all want to help, but because of the years of abuse from failure of hospital administration, the micro management of cms, and the lack of respect from the public.

Being a nurse myself i would never think of abandoning my patients like this, there is a time and a place for protesting- when you are supposed to be on the floor taking care of people is not that time. Your fellow workers had to work 25 hours to cover your selfishness do you really think a nurse can work that long under the same circumstances you are and be physically/mentally able to make live saving decisions. Those nurses should be ashamed of them selves and just for the record they make it sound like they were just told to leave, the were acting childish sitting in the break room for 4 hrs, managers finally came to them and said if your not going to work go home no need for you to be here. Believe me I'm not sticking up for management because it is messed up but having peoples lives at stack there is a better time to protest.

Thank you!!!! I'm not sure the general public will ever understand the vial nature of for profit hospitals. They are chronically understaffed with limited supplies even in the best of circumstances. Nurses are pushed to the absolute limit. This is compounded by patients who are often disrespectful and even violent towards nurses. Yet hospitals are often managed and owned by people who have no experience in direct patient care, these people are heartless and ruthless. If you overload a nurse with critically ill patients and limited supplies someone IS going to die unnecessarily. With Covid19 it could be the patient, the nurse, or the nurse's family member. To expect nurses to work in these types of environments so that someone can make a larger profit is inhumane. And if I were a patient on a vent I would be ever so grateful for my nurse to walk out in order to put a stop to the nonsense, as they stand up for patient rights less patients will die unnecessarily going forward. Or they can continue to kill patients because of poor staffing ratios and allow big $$$ hospitals to cover it up. Everyone has a choice to do the right thing.

ALL LIVES matter! Including Doctors and nurses. I will volunteer my time (which I have more of since being laid off) to make PPE!! WHY arent we doing this? Hospital Administration should be shoulder to shoulder helping who they manage. That would magically pop out enough PPE for sure. Would we chastise a fireman for not going in a burning building if he didnt have his gear??

ALL LIVES matter! Including Doctors and nurses. I will volunteer my time (which I have more of since being laid off) to make PPE!! WHY arent we doing this? Hospital Administration should be shoulder to shoulder helping who they manage. That would magically pop out enough PPE for sure. Would we chastise a fireman for not going in a burning building if he didnt have his gear??

Hospitals are worse than prisons during the pandemic. If you have an emergency other than the virus forget about going to the ER even if you have chest pains, because once they get you in the hospital you are "ALL ALONE ON YOUR OWN"!

They will NOT let your husband/wife be with you you can't contact anyone It's worse than a prison. More people are dying from other causes other than this Coronavirus because they WILL NOT go to the ER for help because they know they will be alone with NO support from not even ONE family member .

Why do they do this if the patient or the loved one DO NOT have this virus but some other life threatening condition they should be allowed to be together! Support from a loved one just to hold your hand and talk is better than any medicine, and the loved one could take some burden off of the nurses so they can take care of other things!

Besides if there are patients who are in the hospital with the Coronavirus aren't they in a special part of the hospital IN QUARANTINE! This country is starting to feel like a Nazi run country they are taking away our freedoms one at a time, there is no more Life, Liberty and The Pursuit of Happiness any longer!!!

Pray you never get sick and have to go to the hospital because if you do YOUR ALONE ON YOUR OWN!!!